Date: 96-02-07 14:16:13
EST
From: DrDenise@aol.com
Subject: Re: HEALTH - Anesthesia
There is no way to test for an anaphylactic reaction
to anesthesia prior to the procedure, as it would be similar to
predicting an allergic reaction to a bee sting when you have never had one
before. There are ways to minimize the risks to anesthesia prior to the
procedure. At our clinic we recommend pre-anesthetic bloodwork, with different
levels for different age groups, such as up to 3 years--- a kidney test, a
liver test, and a CBC to check red and white cells (looking for anemia and active infection
or inflammation) as well as platelet levels for
clotting; for 3 to 6 years----a panel of 5 tests and the CBC; for geriatric patients, we
recommend a full blood screen.
These are just basic guidelines, and other
recommendations may be made in special circumstances. If things are abnormal here or
on physical exam, we may recommend further tests.
For anesthetics, the safest by far are the gas
inhalation agents, such as isoflurane. These are delivered thru tracheal tubes
and carried by oxygen.
This gas is recommended for use in geriatric patients
or those with health problems, as well as exotics, as the margin of safety
is very high; if a complication occurs, the gas can be stopped and
oxygen alone delivered.
Isoflurane is almost completely blown off by the
lungs rather than going thru liver and/or kidneys to be removed from the
body. Usually animals need a preanesthetic or induction agent before
starting on the gas, and my personal favorite is ketamine/valium given IV (that
is what I use on my ear crops on the Bouvier pups). The type used depends
on the anesthetists experience and personal preferences.
Health problems that cause problems with anesthesia
are heart conditions, where the stress of anesthesia can cause and
exasperation of the conditions, or other metabolic problems, such as
liver or kidney disease, diabetes, to name a few. These can be detected
oftentimes with a preanesthetic workup. I did not want to make everyone
believe that anesthetic accidents and reactions never occur and
there is no risk to anesthetic procedures, but the risk is minimal when
anesthesia is done properly and with care. When you consider the number
of procedures performed under anesthesia during a year in a vet
practice (probably around 1000 per doctor in the average practice), and
how very few problems do occur, the chances are very slight in having a
problem. I do feel, however, that certain breeds or certain bloodlines
within a breed may be more sensitive to anesthesia than the norm, and
Bouviers as a whole seem to be among those. In general I have found that
Bouviers require less for induction of anesthesia, and lower flow rates of gas
inhalant to maintain them. For some individuals, it may be as low as what
is needed for a 30 pound dog!!! A story about this point: when I was a
senior in vet school, I brought my male Bouv (my first one) in for a teeth
cleaning. I mentioned to the anesthesiologist and to my friend who was
administering the anesthesia that I felt Grizz was sensitive to
anesthesia. The anesthesiologists and techs laughed at me and
said they heard that from all owners. My friend believed me. She gave
Grizz a preanesthetic, but decreased the usual dose to 75%. This is normally
followed about ten minutes later with IV induction, then the gas. I took
Grizz outside to "potty" and started back in-----we had to
walk down a long hallway to get back to the surgical prep area, about 100 feet. Just
before we got back to the prep area doorway, Grizz collapsed. He is 95
pounds and no way could I carry him, so I got a guerney. No induction agent was
needed-----he was intubated and started on a low flow rate of gas.
Needless to say, the vets and tech were not laughing any longer. Everytime
Grizz has recieved anesthesia, it required little for induction and
maintanence. Believe me, I tell all my puppy buyers that story, and many have
called back later with similar reports. Part of it is the calm
disposition. I guess I tend to err more on the side of too light anesthetic to
start, then adjust as needed.
-----------------
From: DrDenise@aol.com
Date: Tue, 1 Apr 1997 10:46:53 -0500 (EST)
Subject: Re: HEALTH - Anesthesia
<< i would like some info on anesthesia from dr. denise. henry had a real
scary recovery from his neutering. his heart was
irregular and he just didn't
recover too quickly. >>
Without knowing more about the type of anesthesia used,
it is difficult to
discuss too much. In a new anesthesiology text (came out late last year or
early this year), there was a comment regarding the
sensitivity of the
Belgian breeds to anesthesia, and I have seen that to be
true, for not just
the bouvier but for all the belgian herding breeds.
I have, as I stated early, used the Ketamine/Valium
mixture as an induction
agent for anesthesia and maintained on isoflurane
inhalant without incident
for my bouviers, as well as for ear crops on many bouviers. I have also used
different drugs for sedation in the bouviers without
incident, including telazol, and Rompun (similar to the newer Domitor......reversable) mixed with
Torbugesic for OFAs, teeth cleans etc. Most important is
the
anesthesiologists comfort level with the drugs. If there
was a cardiac
arrythmia during the procedure, the Ketamine/Valium and
isoflurane mix would
be a very good option for anesthesia, as it does not
sensitize the myocardium
(heart muscle) to catecholamines released during
excitation phase of
anesthesia. If the procedure is short in duration,
sedation may be a better
option if a surgical plane of anesthesia is not needed,
or if a local block
can be utilized.
DrDenise
------------------------------
From: DrDenise@aol.com
Date: Tue, 1 Apr 1997 10:47:01 -0500 (EST)
Subject: Re: HEALTH
In a message dated 97-03-30 19:05:52 EST, you write:
<< My ten-year-old neutered male Bouv pet
("Qzha," pronounced
"Cue-zha") has broken his tooth and gotten an
infection under the gum. The
tooth fractured vertically on the outside surface. My vet
is hesitant about
using anesthetic to allow him to properly clean it up and
get rid of
infection. He says just antibiotics alone won't do it. He
hesitates
because of the dog's age, especially since he thinks
Bouvs live to be about
ten, usually. He is reluctant to believe that the breeder
said he should
live into his mid-teens. He says it is up to me, but
risky.>>
I would highly recommend doing a pre-anesthetic workup to
determine the
overall health of the dog before making the decision
whether or not to
anesthetize for a procedure. I have anesthetized my own bouvier that was 10
years old for a neuter , teeth cleaning, and tumor removal successfully and
have also anesthetized animals much older than that for
teeth cleanings and
other procedures.......up to a 20 year old cat. The
anesthesia must be
adjusted for the type of procedure and the health of the
dog. Personally, I
utilize a Ketamine/Valium mixture for an induction to
effect and then go with
isoflurane inhalation for maintenance (what I used on my
own 10 year old),
but I am familiar with the combination and have a great
deal of comfort with
its usage. If your own veterinarian does not feel
comfortable anesthetizing
a ten year old bouvier, I would recommend a second opinion and the workup to
determine whether this can be done...........anesthesia
safety is ONLY AS
SAFE AS THE PERSON DOING IT!!!!!!!!!!!
DrDenise
------------------------------
From: DrDenise@aol.com
Date: Tue, 1 Apr 1997 10:46:53 -0500 (EST)
Subject: Re: HEALTH - Anesthesia
In a message dated 97-03-31 22:17:45 EST, you write:
>This past Wed I was discussing OFA procedures with
>Truman's vet as it relates to anesthesia. Because of
my
>hesitancy about general anesthetics, he mentioned a
new
>sedative which is injected & makes the animal
quite
>relaxed and docile.
I believe this is Domitor, great to mix with Torbugesic,
and completely
reversible with Antisedan.......have used it with great
success. Domitor is
very similar to an older drug called Rompun (also reversible), but much more
specific in its action, so a bit safer.
DrDenise
